Nakedize Distribution credit account application form

AUTHORISER’S CONTACT DETAILS - - - - - - -
Title

First name (required)

Surname (required)

Email (required)

Telephone (required)

APPLICANT’S DETAILS - - - - - - -
Name of applicant company (full legal name, 'the Applicant') (required)

Trading name (if different)

Year commenced (required)

Company Registration Number

Telephone (main line) (required)

Physical address (required)

Postal address (required)

Postcode (required)

Bank name (required)

Bank branch name (required)

CREDIT REFERENCES - - - - - - -
Please supply two trade references (excluding banks, utilities, and personal references).

Ref #1 Business Name (required)

Ref #1 Telephone (required)

Ref #2 Business Name (required)

Ref #2 Telephone (required)

ACCOUNTS CONTACT DETAILS - - - - - - -
Title

First name (required)

Surname (required)

Email (required)

Telephone (required)

AUTHORISER'S ACKNOWLEDGEMENT AND CONSENT OF DISCLOSURE - - - - - - -
By completing these three fields and submitting this form, you are providing the consent detailed below and are acknowledging that Nakedize Limited (‘the Company’): has payment terms of 20th of the month following the date of invoice that the Applicant will adhere to; and reserves the right to withhold its services from the Applicant if your account becomes overdue.

I consent that the Company:

- may collect, receive, and use information about the Applicant it regards is reasonably necessary for its credit enquiries, collection, and account administration purposes, from any person it considers appropriate.
- is authorised to provide or receive information which may reasonably be considered necessary to process any credit enquiries regarding the Applicant’s Nakedize Distribution credit account.
- may review its decision to supply, or to continue to supply, the Applicant on credit terms if the Applicant does not provide the Company with the requested information, and that the Applicant has certain rights under the Privacy Act 1993 to access and request correction of information the Company holds about it.
- may use contact details collected in this application to provide the Applicant with information relevant to the Company’s distribution service.

Name (required)

Designation (required)

Date (required)